Medicaid paid for nearly half of the nation’s $263 billion long-term care expenditures in 2010. Federal law discourages individuals from artificially impoverishing themselves in order to establish financial eligibility for Medicaid. Specifically, those who transfer assets for less than fair market value during a specified time period before applying for Medicaid may be ineligible for coverage for long-term care for a period of time. The Deficit Reduction Act (DRA) extended the look-back period to 60 months and introduced new requirements for the treatment of certain types of assets, such as annuities, in determining eligibility. States are responsible for assessing applicants’ eligibility for Medicaid, the criteria for which varies by state.
The Government Accountability Office (GAO) was asked to provide information on states’ requirements and practices for assessing the financial eligibility of applicants for Medicaid long-term care coverage. In a report on Medicaid and long-term care, GAO examined the extent to which states (1) require documentation of assets from applicants, (2) obtain information from third parties to verify applicants’ assets, and (3) obtain information about applicants’ assets that could be used to implement eligibility-related DRA provisions.
The report found that states varied in the extent to which they obtained information from third parties to verify applicants’ assets. On the basis of states’ responses to questions about the extent of documentation required from applicants and information obtained from third parties, it is unclear whether some states obtain sufficient information to implement certain provisions of the DRA. For example, 31 states reported requiring less than 60 months of documentation from applicants and financial institutions.
February 20, 2014
The Government Accountability Office (GAO) released a new report
citing how Medicaid spends a third of their funds on a small sect of high-expenditure Medicaid beneficiaries. The report, Medicaid: Demographics and Service Usage of Certain High-Expenditure Beneficiaries
, found that states spent 31.6% of all Medicaid expenditures on 4.3% of the Medicaid population. Furthermore, the report stated that certain characteristics, such as residing in a long-term care facility, contributed to individuals being deemed high-expenditure Medicare beneficiaries.
August 10, 2012
The National Association of Medicaid Directors sent
a letter to the Centers for Medicaid and CHIP Services (CMCS) Director Cindy Mann including recommendations on how to improve federal policies and procedures regarding managed long term supports and services programs.
August 7, 2012
A growing number of state Medicaid agencies are planning to launch or expand programs that offer risk-based contracts to managed care organizations (MCOs) to provide long-term services and supports (LTSS)—and, in some cases, acute and primary care—to older adults and people with disabilities. Because these individuals often have one or more chronic health conditions, they tend to use more health services than younger people and people without disabilities. In addition, they often depend on other services and supports such as personal care to perform activities of daily living, such as bathing and eating.
In risk-based managed care arrangements...
June 6, 2012
The Congressional Budget Office presents
the long-term budget outlook under two scenarios in a new report. These scenarios embody different assumptions regarding future policies governing federal revenues and spending. The first, the extended baseline scenario, reflects the assumption that current laws generally remain unchanged and that lawmakers will allow changes that are schedule under current law to occur, forgoing adjustments routinely made in the past that have boosted deficits. The second, the extended alternative fiscal scenario, incorporates the assumptions that certain policies that have been in place for a number of years will continue and some provisions of law that might be difficult to sustain for a long period will be modified.
These two scenarios span a wide range of possible policy choices. The report focuses on the next 25 years and gives special focus to outlays for major health care programs.
Under both scenarios, the report estimates that total outlays for federal health care programs will grow much faster than the gross domestic product (GDP), increasing from 5.4 percent of the GDP in 2012 to nearly 10 percent in 2037. National health care spending is also expected to rise. Health care expenditures is expected to increase to almost one-quarter of the GDP by 2037. CBO suggested that key factors contributing to this growth in spending have been the emergence of new medical technologies, rising personal income, and the expanding scope of health insurance coverage.
October 17, 2011
The United States Government Accountability Office (GAO) released a report
, "Long-Term Care Hospitals: CMS Oversight is Limited and Should Be Strengthened," which recommends that the Centers for Medicare & Medicaid Services (CMS) strengthen its oversight of long-term care hospital (LTCH) survey activities and improve data collection on quality of care. LTCHs specialize in the provision of care to individuals with multiple or chronic conditions. CMS does currently collect data on the quality of care at LTCHs, but the GAO argues that the data are limited for several reasons. First, CMS does not have detailed data on survey results conducted by The Joint Commission (TJC) prior to 2009. Second, CMS does not currently collect data on LTCH quality measures regarding health care delivery because LTCHs are not required to report them. However, under the ACA, LTCHs will be required to make such reports beginning in 2014.
September 20, 2011
President Obama sent "Living Within Our Means and Investing in the Future: The President's Plan for Economic Growth and Deficit Reduction," his plan
to jumpstart economic growth and job creation, to the Joint Committee yesterday. The plan proposes additional savings on top of those signed into law under the Budget Control Act. Specific to health savings, the President recommended cuts to erroneous and wasteful spending under Medicare and Medicaid. He stressed that he would "veto any bill that takes one dime from the Medicare benefits seniors rely on without asking the wealthiest Americans and biggest corporations to pay their fair share."
March 9, 2011
The Patient Protection and Affordable Care Act (ACA) has the potential to help States reorient their systems of long-term care. The goal is to move away from nursing homes and institutional care and toward a greater emphasis on home- and community-based services. This will enable States to both meet a broad range of needs and support family caregivers. The report
, "How The Affordable Care Act Can Help Move States Toward A High-Performing System Of Long-Term Services and Supports," published by Health Affairs, outlines five key characteristics of a high-performing system of long-term services and supports. The paper describes an emerging "scorecard" that could help measure states' progress toward this goal. Finally, the Health Affairs piece highlights aspects of the ACA which will support the creation of such a high-performing system for the disabled and those with chronic conditions.
January 7, 2011
In a letter
to Speaker of the House John Boehner, the Congressional Budget Office (CBO) notified Congress that the recently-introduced bill aimed at repealing the Afforadable Care Act (ACA) would add approximately $230 billion to federal deficits during the years 2012 - 2021. CBO also estimates that the bill
, H.R. 2: Repealing the Job-Killing Health Care Law Act
, would increase the number of uninsured Americans by 32 million over the next decade.
February 18, 2011
Approximately 10 million American seniors and individuals with disabilities need long-term services and supports (LTSS), and the number is expected to increase to nearly 21 million by 2040. Private long-term care insurance represents only a fraction of long-term care financing, due to a host of issues ranging from the high cost of insurance premiums to concerns about the high rate of coverage denials. Medicare only covers short-term skilled nursing care services and home health services, and Medicaid, the primary payer of LTSS (almost 50%), covers a range of services, but is only available to low-income individuals with disabilities. In the Patient Protection and Affordable Care Act (ACA), Congress addressed the long-term care needs of the elderly and disabled by making a number of changes in Medicaid coverage of home and community based services, and by establishing the Community Living Assistance Services and Support (CLASS) program, a voluntary, federally administered health insurance program designed to assist eligible individuals in purchasing long-term community living services and supports.